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High School Coaches Know Concussion Signs but Don’t Act

High school coaches have a good understanding of the signs and symptoms of concussion, but they often don’t make the right management decisions, a new survey shows. That’s where athletic trainers come in, said Meredith Madden, athletic trainer at Boston College who did the survey and reported the results June 26 at the National Athletic Trainers’ Association (NATA) annual convention.

“Most of our coaches are there for a very specific job description — to coach. Athletic trainers are important members of the team and at the end of the day it’s our job to keep the kids safe. Not every hit to the head will result in a concussion, but that is up to a qualified athletic trainer to determine, not a coach,” Madden noted in an interview with Reuters Health. Madden and colleagues got 104 Massachusetts’ public high school coaches to complete an online survey to test their knowledge of concussion signs and symptoms and management. They also interviewed 12 coaches by phone or in person.

Most of the coaches correctly identified symptoms of confusion (94%), headache(94%), dizziness (91%) and blurred vision (90%) as indicators of a concussion. Most also identified loss of consciousness (87%), nausea (82%) and amnesia (75%) as indicators of concussion, but fewer than half (42%) recognized sleep problems as a sign of concussion. About one in 10 associated non-concussion symptoms as primary indicators of concussion, which suggests that they are unable to distinguish concussion symptoms from other injuries and lack in-depth knowledge or understanding about concussion, the researchers say. Over 90% of coaches knew appropriate management strategies in typical concussion scenarios, but when faced with atypical scenarios, only 57% would appropriately remove an athlete from play.

“The coaches had really good knowledge about signs and symptoms of concussion,” Madden told Reuters Health. “But when we looked at their overall management, they often weren’t making the right decisions. This suggests that they know what to look for, but they don’t necessarily know what to do, or they are uncertain, or there is some other conflict that is coming into play.”

Larry Cooper, head athletic trainer, Penn Trafford High School in Harrison City, Pennsylvania, and Chair of the National Athletic Trainers’ Association Secondary School Committee, told Reuters Health, “We have come a long way in educating coaches and they certainly have increased their knowledge of concussions and certain things to look for but we still have a ways to go.” This survey “underlies what we have been trying to push all along and that is to have an athletic trainer in every secondary school,” said Cooper, who wasn’t involved in the survey.

“With concussion evaluation and management, or any other type of injury, the athletic trainers are the health care professional that can do it, regardless of the sport, the event, the score, and provide even-keel medical evaluation,” he said. He added that coaches’ ability to evaluate an athlete “with a neutral mind is sometimes lacking.”

“Athletic trainers are the ones who should decide whether an athlete stays in the game or doesn’t. Any coach in their right mind would not want to take that on, just because that is not what they are trained to do. We’re the ones providing the health care, the coaches are the ones doing the coaching,” Cooper said.

Madden added, “We all want to make athletics safe, because they are a good vehicle for our students for character development and for scholarships. We have qualified athletic trainers to assess and provide care for our student athletes.”